Canine Epileptoid Cramping Syndrome

 

   CECS/SD SURVEY

If you have a dog that is known to have CECS/Spike’s Disease or you have observed your dog exhibiting suspicious or abnormal behavior indicating he/she might have this disorder, it would be most helpful if you would kindly fill out the following survey. Once filled out, just click on the "Submit" button on the bottom of the form and the results will automatically be e-mailed to Kris Blake. The information on this form will be used for research purposes only. Please keep typed answers as brief as possible.

It is suggested that you print out this form to use as a worksheet. Then once you have filled that out, come back and transfer all the info to this online form. If you leave the form to go to another page or site, you will lose what you have filled out to that point.

Please take care to only click on "tab" and not "enter". Clicking "enter" will submit the form prematurely. Should that happen, simply click on your browser's back button and it will return you to the form without losing what you have typed. Do not click on "Return to form".

Registered name of the dog: 

Call Name:     

Breed of Dog:

Date of Birth and Date of Death (if applicable):   
(Example: 00/00/0000 or if the dog has died you would enter 00/00/0000 to 00/00/0000)

Gender: Male      Female

Color: 

Spayed/Neutered? YES      NO

 

General questions regarding the episodes:

  1. How did you find out your dog might be suffering from CECS/Spike’s Disease?

  2. Has your dog ever shown signs of unexplainable strange episodes, spells, shaking, or excessive stretching?   YES      NO

  3. At what age was the onset of CECS/SD symptoms first observed?
    1-3 years   
    4-6 years  
    6-8 years
    Over 8 years

  4. Does your dog behave abnormally before an episode? If so please describe:

  5. How long do the episodes last?
    0-1 minute
    1-4 minutes
    5-10 minutes
    10-30 minutes
    Longer

  6. How often do these episodes occur?

  7. Have you noticed any change in the duration and intensity since your dog had his first episode?     YES      NO

  8. Have you noticed anything that you might consider a ‘trigger’ to your dog’s episodes? If answer is "YES", please mark the noted cause:

    Extreme excitement
    Stress
    Changing weather or extremes in the weather
    Food
    Treats
    Change in environment
    Vaccinations
    Surgery
    Interrupted sleep patterns
    Other

  9. If you marked anything in Question #8, please explain:

  10. Have you noticed any clusters of episodes? (Clusters are a cramping episode, followed by a period of recovery, then having another episode immediately after the recovery.)  YES      NO

Symptoms displayed during the episode:

  1. Does the dog appear conscious or responsive to you?  YES      NO

  2. Does the dog (please mark each behavior that applies during an episode):

    Stand
    Sit
    Fall down
    Lie down
    Drool
    Throw up bile
    Shake or tremble
    Act dizzy
    Lose control of bladder or bowel
    Stretch excessively
    Show signs of stiffness or pain
    Move toward you when called
    Show repetitive motions
    Accept food or a treat
    Refuse food or treat
    Other (Please explain below)

  3. What does the dog’s mental state appear to be during an episode? (Mark each that applies.)

    Fear or Anxiety
    Exhibit signs of wanting to isolate or hide
    Insecure and wanting to be held

  4. Does he have visible signs of muscle cramping? If so, what part/parts of the body are affected?

    Head & neck
    Shoulders & front legs
    Abdomen and lumbar (back) region
    Rear legs & feet
    Tail (sometimes arches)

  5. Does the dog suffer from loud intestinal noises, cramping and/or apparent pain during an episode which affects the intestines?   YES      NO

After an episode:

  1. Does your dog behave abnormally for a period of time immediately after the episode?   YES        NO

  2. How long after does it typically take your dog until he/she is behaving normally again:

    Less than 5 minutes
    5-10 minutes
    10-30 minutes
    Longer

  3. Have you ever noticed any of the following immediately following an episode?

    Blood in the feces
    Diarrhea
    Mucus in the stool
    Rise in body temperature
    Rapid heart rate

  4. Did you have your vet examine your dog because of these episodes?
    YES       NO

  5. Have you ever taken your dog to your veterinarian to get medical intervention to stop the episodes?  YES       NO

  6. Was the dog’s blood tested and if YES, what was he/she tested for?

CBC/Serum chemistries

Not performed

Normal

Abnormal

Don't know results

Liver function (Bile acids or ammonia)

Not performed

Normal

Abnormal

Don't know results

Bile Acid Stimulation Test

Not performed

Normal

Abnormal

Don't know results

Ultrasound of liver

Not performed

Normal

Abnormal

Don't know results

CT or MRI

Not performed

Normal

Abnormal

Don't know results

EEG

Not performed

Normal

Abnormal

Don't know results

If possible, please send a copy of the original test results sheet. (Contact Kris Blake for address of where to send. If you have a problem filling out this form, please print it and then mail it to Kris after you have filled it out.)

Treatment:

  1. Has your vet ever prescribed medication for your dog in relation to his/her episodes?  YES       NO

  2. If you answered "YES" to Question #22, list the medication/s and what was the dosage and length of time the dog was on the medication?

  3. How did the dog respond to this medication?

  4. Did you stop giving your dog the medication and if YES, what was the reason?

  5. Have you used any herbal, holistic or supplements on your dog? If so, what kind and what were the results?

 Food

  1.  What kind of food was your dog on when the episodes first began:

    Brand and type (kibble or canned):


    Other (i.e. home prepared food etc):

  2. If your dog was given treats/snacks during the time frame of his/her having episodes, what type and brand?

  3. Have you ever given your dog high protein treats or chews? If so, what kind or type?

  4. Have you ever tried some of the foods that are mentioned on the CECS/SD site? If YES, what types/brands and what were the results?

  5. Has your vet ever prescribed a prescription food for your dog? If so, what kind and what were the results?

     

The following symptoms may not necessarily be symptoms of CECS/Spike’s Disease, but we would like you to answer the following questions for research purposes:

  1. Does your dog suffer from any other kind of medical conditions? If so, please briefly explain:

  2. Does the dog experience any problems with any of the following?

    Ears
    Skin
    Allergies
    Eyes
    Hypothyroidism
    Chronic bowel, urological, or genital difficulties
    Symptoms of Intestinal Bowel Disease

  3. Does your dog have a good appetite? If not, please explain:

  4. Does your dog exhibit any of the following?

    Excessive paw licking
    Nose licking
    Licking at the air

  5. Has your dog had a reaction to any of the following?

    Changes in food or treats
    Inoculations
    De-worming
    Flea control
    Heartworm preventative
    Surgery

    If you checked the boxes to any reactions, please explain what occurred:

We want to express our appreciation for your taking the time to fill out this form. We are gathering this information in hopes that at sometime in the future it may aid researchers in diagnosing and discovering a treatment for this devastating disorder/disease. We hope you will also consider submitting a blood sample to the University of Missouri to aid in their DNA research. (CECS Forms Package can be found on the Faq’s page)

IMPORTANT: Should you notice any changes in your dog’s condition, it is important that you contact Kris Blake to provide her with that updated information.

Comments or suggestions:

It would help if you would give us your name and phone number and/or e-mail address so that we could contact you if we had questions. However, that is entirely up to you. You may submit this survey form anonymously if you prefer.

 Pet owner's name:
 Phone #:
(Example: xxx xxx-xxxx)
 E-mail Address:

Marilyn Reed, Webmaster
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Revised: 03/29/10.

 

 

                                             

 

 

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